Merchants

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Merchant ID

Legal Name

DBA Name

Processor

Agent

Split

Is Override

Password

Received Date

Approved Date

Activation Date

Closed Date

Product Type

Status

Address

Address 2

City

ZIP

Country

State

Contact

Email(comma separated)

Phone

Phone 2

Cell

Fax

URL

DBA Same as Legal Address

Address

City

ZIP

Country

State

Mailing Address Same as DBA

Address

City

ZIP

Country

State

File here *	Download	Notes *	Status	Date

Type

Install Date

Equipment ID

Status

Model

Purchase T.

PD Telephone

Sales Rep

Serial #

Tracking #

TID

Employee

Purchase Date

Type

Install Date

Equipment ID

Status

Model

Purchase T.

PD Telephone

Sales Rep

Serial #

Tracking #

TID

Employee

Purchase Date

Bank 1 Information

Bank Name

Account Name

Rounting Number

Account Number

Billing Type

Gross Settlement

Net Settlement

Bank 2 Information

Bank Name

Account Name

Rounting Number

Account Number

Overrides who receive partial commission on all of Elite Total Health Accounts

Default Setup

Agent 1 Receives

%

on all Newly Inputted Accounts

Agent 2 Receives

%

on all Newly Inputted Accounts

Agent 3 Receives

%

on all Newly Inputted Accounts

Agent 4 Receives

%

on all Newly Inputted Accounts

Processor wise Setup

Select Processor *

Agent 1 Receives

%

on all Newly Inputted Accounts

Agent 2 Receives

%

on all Newly Inputted Accounts

Agent 3 Receives

%

on all Newly Inputted Accounts

Agent 4 Receives

%

on all Newly Inputted Accounts

Select Processor *

Agent 1 Receives

%

on all Newly Inputted Accounts

Agent 2 Receives

%

on all Newly Inputted Accounts

Agent 3 Receives

%

on all Newly Inputted Accounts

Agent 4 Receives

%

on all Newly Inputted Accounts

Merchant *

Month *

Year *

Merchant CMS

EIN/Federal Tax ID Type

MCC Code

EIN/Federal Tax ID #

Type of Legal Entity

State incorporated in

Types of Goods Sold

Primary Transaction Type

Internet

%

Swipe

%

Keyed

%

Average Ticket

Telephone Order

%

Annual Volume

Business Start Date

High Ticket

Persoanl Guarantor

Monthly Volume

Discount Method

Refund Policy

30 Days

60 Days

Other

None

Date

Reminder Date & Time

Employee

Notes

Sr. No.	Date	Reminder Date	Employee	Note	Action
1	Aug 01 2023			User: Charlotte Goff -> Notes: Christina called back and I relayed the message about the cost of the B-250 reader and payment of the invoice to have verbally.
2	Aug 01 2023			User: Charlotte Goff -> Notes: Spoke to Christina Brown. She said they've been having issues with their B-250 bluetooth reader. They called Swipe Simple and Swipe Simple tried to do the latest update on it but it still would not accept any of the apple pay or EMV cards. Swipe Simple told her to call us that we needed to send her a replacement reader. I called Christina back at 901-833-7233 but received voicemail. I left her a message stating that we can order the B-250 today and that we would send her an invoice for the $125 cost of the reader PLUS shipping and tax. I did let her know that she would have to pay the invoice before we will ship the reader.
3	Aug 01 2023			User: Pennye McAnulty -> Notes: Need assistance setting up IQ to view statements. I created her an account and had it send her a password to complete the setup. She verified that she did receive the email and will call back if she has issues.
4	Aug 01 2023			User: Pennye McAnulty -> Notes: TT they are wanting to try swipe simple. I sent her the paperwork.
5	Aug 01 2023		Mike Thomas	User: Mike Thomas -> Notes: Sent MP200 via courier SN: 315183801616
6	Aug 01 2023			User: Pennye McAnulty -> Notes: Sending a replacement reader they are getting an error message of Tamper Detected.
7	Aug 01 2023		Mike Thomas	User: Mike Thomas -> Notes: Sent replacement MP200 via Morgan. SN: 315181100316
8	Aug 01 2023		Mike Thomas	User: Mike Thomas -> Notes: Ordered new reader (5/16/18)
9	Aug 01 2023		Mike Thomas	User: Mike Thomas -> Notes: Delivered new device, no longer getting the error message of invalid key was working fine on all test. Still no live EMV card the requires a pin.
10	Aug 01 2023		Mike Thomas	User: Mike Thomas -> Notes: TT Tina, no way to connect 520 she asked for me to wait until 4/12/18 (tomorrow) to bring new MP200
11	Aug 01 2023		Mike Thomas	User: Mike Thomas -> Notes: Went to location to trouble shoot with USA ePay, TSYS, and Vantiv. After several hours it was determined that the MP200 will need the debit injection (FFFF530423) Pos Portal is now researching if they can provide that key. I will deliver VX520 upon arrival today.
12	Aug 01 2023		Mike Thomas	User: Mike Thomas -> Notes: Added Mymerchantdata.com
13	Aug 01 2023			User: Pennye McAnulty -> Notes: TT nicole needed ach change form
14	Aug 01 2023		Mike Thomas	User: Mike Thomas -> Notes: Advised Nicole how to view reports and batch history
15	Aug 01 2023		Mike Thomas	User: Mike Thomas -> Notes: UN elite_th PW Southmain263
16	Aug 01 2023		Mike Thomas	User: Mike Thomas -> Notes: TSYS VAR completed, set up USA ePay.

Application Type

Discount

Business Type

MCC Code

Visa/MC/Discover Rate Category

Base/Qualified (%)

Mid Qualified (%)

Non Qualified (%)

Base Debit- Non Pin Debit(Sig Debit Rate) (%)

Rewards Discount (%)

Statement Fee

Card On File Fee

PCI Fee

Non PCI Compliance

Authorization Fee

Per Item Fee

EBT Fee

FNS/EBT Number

Pin Debit Item Fee

Pin Debit Discount

Amex Opt Blue Rate

Base/Qualified Rate (%)

Mid Qualified Rate (%)

Non Qualified Rate (%)

Program Cost Opt Blue (%)

Authorization Fee

Per Item Fee

Other Monthly Fee

Ancillary Fees

Batch Fee

Retrievel Fee

Chargeback Fee

ACH Change Fee

Voice Auth Fee

Gateway Monthly Fee

Setup Fee

Owner 1 Information

Officer/Owners Name

Title

Social Security

Form of ID

ID #

Issue Date

Expiration Date

State

DOB

Home Phone Number

% of Business Owned

Length of Ownership

Y N

Home Address

Home city

Home state

Home country

Home zip

Owner 1 Information

Officer/Owners Name *

Title

Social Security

Form of ID *

ID # *

Issue Date *

Expiration Date *

State *

DOB *

Home Phone Number

% of Business Owned

Length of Ownership

Y N

Home Address *

Home city *

Home state *

Home country

Home zip *

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